动态24小时食管pH监测对GERD的诊断价值

采用自行研制的动态24小时食管pH监测系统对16名健康受试者及45例GERD患者进行了检测.提出了初步的生理性GER标准.对病理性GER诊断.以总pH<4百分时间敏感性最高(87%).返流次数最低(62%).而各指标的特异性在93～100%.结果表明:该法是GERD诊断及研究的重要方法.我们推荐总pH<4百分时间作为GERD诊断的最好的单一指标.     

幽门螺杆菌相关性慢性胃炎患儿的食管24小时的pH变化

目的 :探讨慢性胃炎患儿幽门螺杆菌 (HP)感染与病理性胃食管反流 (GER )的相关性。方法 :所有病例都作胃镜检查和粘膜组织学检查 ,诊断慢性胃炎HP阳性 2 6例 ,HP阴性 17例 ,采用便携式食管 pH自动记录仪 ,监测两组患儿的食管 2 4hpH值 ,对监测结果进行对比研究。结果 :HP阳性的慢性胃炎发生病理性GER 6/2 6例 (占 2 3 0 8% ) ,HP阴性的慢性胃炎发生病理性GER 6/17例 (占 3 5 2 9% ) ,两组差异无显著性 (P >0 0 5 )。HP阳性组pH <4反流次数和最长酸反流时间小于HP阴性组 ,差异有显著性 (P <0 0 5 )。反流 >5min次数 ,pH <4总时间 ,pH <4时间百分比和食管清除率两组差异无显著性 (P >0 0 5 )。结论 :HP感染与病理性GER的发生无明显相关。     

支气管哮喘病人24小时食管pH监测的临床分析

目的　观察哮喘发作期及缓解期患者食管 2 4hpH的变化 ,研究胃食管反流 (GER)病人应用抑酸剂后食管 pH或肺功能的改变情况。方法　对 5 1例哮喘病人进行了研究 ,其中 30例病人比较发作期及缓解 2周后的 2 4h食管 pH指标 ,对 16例伴有GER的哮喘缓解期病人 ,应用奥米拉唑治疗 ,比较治疗前及治疗 2周后肺功能指标。对 15例伴有GER的急性哮喘发作病人应用奥米拉唑治疗 ,比较治疗前及治疗 2周后 2 4h食管 pH的变化。结果　哮喘发作期及缓解期 2 4h食管pH各项指标与正常对照组比较显著升高 (P <0 0 1)。 16例伴有GER的哮喘缓解期病人 ,应用抑酸剂后肺功能有明显改善 (P <0 0 5 )。 15例伴有GER的哮喘急性发作期病人经抑酸剂治疗后 ,13例食管 2 4hpH监测的各项指标明显降低 (P <0 0 1)。结论　哮喘急性发作期及缓解期 ,GER发生率显著升高 ,有GER的哮喘病人肺功能有明显改变 ,对哮喘发作的病人 ,需常规进行食管 2 4hpH监测 ,发现有GER的病人 ,可采取质子泵抑制剂治疗     

含餐8 h食管pH监测与常规24 h pH监测对胃食管反流病的诊断价值比较

目的探讨含餐8h食管pH监测对胃食管反流病(GERD)的诊断意义,并以常规24hpH监测为标准验证其灵敏度及特异度。方法对2003年3月至2006年9月北京大学人民医院消化科221例患者进行食管测压和pH监测。首先由系统计算24h DeMeester积分,≥14.72分诊断为胃食管反流病。入选患者晚餐开始共计8h的监测数据,同样计算DeMeester积分,相同的标准诊断胃食管反流病。比较两种方法的一致性及积分的相关性。结果221例患者经常规24hpH监测诊断胃食管反流病124例,正常97例,含餐8hpH监测方法诊断胃食管反流病120例,正常101例。含餐8h的灵敏度为93.5%,特异度95.9%,经Kappa及Mc-nemar检验2种方法具有良好的一致性,部分结果的差异不具有显著性。2种检测方式DeMeester积分的相关系数为0.929。结论含餐8小时监测法和24hpH监测法具有良好的一致性,有望用于GERD特别是内镜阴性GERD的诊断。     

24 h食管pH监测在小儿临床的应用

目的：探讨24h食管pH监测在小儿临床的应用及其意义。方法：对43例患儿进行24h食管pH监测，其中反复呕吐症状为主者29例和以反复呼吸道症状或哮喘发作为主者11例。并对12例诊断为病理性胃食管反流患儿经治疗后进行复查。以11例无消化道症状并排除消化系统疾病和肺支气管疾病儿童作为对照。监测指标有食管pH＜4．0的次数、反流时间≥5min的次数 、最长反流时间、反流时间、立位和卧位pH值＜4的时间占总监测时间的百分比以及Biox-0choa评分。结果：32例存在胃食管反流（GER），占74．4％。各项反应指标的监测结果与对照组的比较和治疗前后反流指标的变化均有显著性差异。结论：通过24h食管pH监测判定反流类型，不仅提高了病理性GER的诊断率，而且不不同临床类型的反流治疗方案的确定提供了根据，尤其是反复呕吐、反复呼吸道病变及新生儿呕吐的病因诊断和疗效观察中具有重要意义。     

24h食管pH监测在胃食管反流病的临床应用

目的　应用 2 4h食管 pH监测仪 ,检测食管下段 pH值 ,旨在为胃食管反流病 (GERD)提供灵敏性和特异性较高、先进而方便、快捷的诊断方法。方法　正常对照组 2 0例 ,消化性溃疡 5 4例及GERD组 85例 ,均采用Digi trapperMKⅢ 2 4hpH监测仪记录下食管括约肌 (LES)上 5cm处 pH。 结果　GERD组 2 4h食管pH监测有关指标均分别显著高于对照组和消化性溃疡组 (P <0 0 1) ,后二者间比较差异无显著性 (P >0 0 5 ) ;GERD组中有 2 4例内镜无异常的异常反流患者 ,其 2 4h食管 pH监测与 6 1例反流性食管炎比较 ,无显著性差异 (P >0 0 5 )。结论　GERD的症状分析和内镜诊断均有其局限性 ,2 4h食管 pH监测是GERD诊断的确切标准。     

十二指肠球部溃疡伴胃食管反流患者食管动力及胃内pH值监测

目的：探讨胃食管反流(GER)常见于十二指肠球部溃疡的原因。方法：选择近5年我院接受胃食管动力检查并行胃镜检查明确诊断为十二指肠球部溃疡的患者46例。食管pH监测胃食管酸反流阳性或胃镜检查存在反流性食管炎(RE)者为反流组，食管pH值监测胃食管酸反流阴性者为非反流组。比较两组食管下括约肌(IES)、食管体部及食管上括约肌(UES)等功能差别，同时对两组胃pH值监测进行比较。结果：十二指肠球部溃疡患者为GER／RE的高发人群，反流组与非反流组LES长度、功能压、食管体部清除功能、UES静息压比较差异无显著性。反流组每日不同时限胃酸分泌高于非反流组。结论：十二指肠球部溃疡易合并GER／RE与胃酸增高有关，与食管动力变化关系不大。     

24小时食管pH监测插管56例体会

便携式 2 4小时食管 p H监测是诊断胃食管返流性疾病的重要指标 ,监测过程中常常遇到一些问题影响了监测。本文旨在分析影响因素的产生及预防所采取的措施。资料与方法 :进行 2 4小时食管 p H监测的患者共 5 6例 ,男 3 5例 ,女 2 1例 ;年龄 2 7～ 70岁。其中 2 8例曾行胃镜检查。方法 :插管前患者禁食 6小时 ,取端坐位 ,湿润鼻腔 ,轻柔地将导管送入鼻腔 ,进管大约 15 cm时嘱患者头前倾 ,下颌贴在胸壁上 ,正常呼吸并做吞咽动作 ,术者缓慢送管 ,将导管插至所需要的深度后 ,用胶布妥善固定在鼻部及颊部。结果 :5 6例插管患者中 ,插管 1次 3 7…     

小儿非心源性胸痛与胃食管反流的关系

目的了解小儿非心源性胸痛(NCCP)与胃食管反流(GER)的关系,探讨食管pH值监测在小儿NCCP诊断中的意义。方法对36例(病例组)诊断为NCCP并排除呼吸系统和胸部肌肉骨骼病变患儿进行24 h食管pH值监测,其中20例行胃镜检查。根据食管炎诊断标准,诊断为食管炎(食管炎组)11例,非食管炎(非食管炎组)9例。结果病例组24 h食管pH值<4、反流≥5 min、最长反流时间、酸性反流指数、Boix-Ochoa评分分别为(60±7)次、(2．44±0．74)次、(12．4±2．8)min、6．72±1．39、(24．6±3．9)分,对照组分别为(33±4)次、(0．35±0．11)次、(4．3±0．9) min、1．25±0．19、(7．7±0．9)分,两组比较差异有统计学意义(t分别=3．44、2．79、2．73、3．89、4．24, P均<0．01);以Boix-Ochoa评分>11．99为病理性GER诊断标准,病例组GER阳性为58．3％(21／36)。20例经胃镜检查的患者中诊断为食管炎为55．0％(11／20),其中GER阳性为81．8％(9／11);诊断为非食管炎为45．0％(9／20),其中GER阳性者为33．3％(3／9)。食管炎组反流≥5 min、酸性反流指数分别为(5．8±2．0)次、12．5±3．5,非食管炎组分别为(0．9±0．5)次、3．4±1．4,两组比较差异有统计学意义(Z分别=-2．400、-2．545,P均<0．05);食管炎组24 h食管pH值<4、最长反流时间、Boix-Ochoa评分分别为(73±11)次、(26±7)min、(41±10)分,非食管炎组分别为(34±11)次、(4±3)min、(14±5)分,两组比较差异有统计学意义(Z值分别为-2．926、-2．675、-2．584,P均<0．01)。结论GER是小儿NCCP的重要原因,食管pH值监测有助于小儿NCCP的病因诊断,并能指导治疗。     

支气管哮喘患者与胃食管返流的症状相关性

目的　探讨胃食管返流 (GER)与成人中、重度支气管哮喘的症状相关性 ,了解 2 4h食管pH监测对哮喘合并GER的诊断价值及抗返流治疗对合并GER的哮喘患者症状的影响。方法　对 2 6例常规治疗后仍有顽固性咳嗽等症状的成人哮喘患者进行 2 4h食管pH监测 ,严格记录监测期间患者出现的各种症状 ,每小时记录 1次呼气峰流速 (PEF)。筛选出适当病例分组抗返流治疗并观察疗效。结果　 2 6例中有 15例DeMeester总积分≥ 14 72 ,2例虽DeMeester总积分 <14 72 ,但咳嗽与返流的症状相关概率 (SAP)≥ 95 % ,共筛选出 17例。将 17例患者随机分为治疗组 (9例 )和对照组 (8例 )。经抗返流治疗后 ,治疗组咳嗽、胸闷和胸骨后烧灼感等症状均较对照组有明显改善 ,2 4hPEF波动率治疗前 [(3 8± 8) % ]、后 [(16± 3 ) % ]比较差异有显著性 (P <0 0 5 )。结论　 (1)中、重度支气管哮喘患者具有较高的GER发生率 (5 8% )。 (2 ) 2 4h食管pH监测有助于了解哮喘患者的症状与GER的相关性。 (3 )对于有GER并与哮喘症状密切相关的患者 ,抗返流治疗可显著地改善其症状及PEF波动率     

Validation of an Ambulatory Esophageal pH Monitoring System

The present study documents the accuracy of a commercially available ambulatory esophageal pH instrument. The distal esophagus of five subjects with daily heartburn was monitored for 24 h in the laboratory via an antimony pH electrode. The computer output from the ambulatory unit was compared to the on-line recording in terms of all events in which the pH dropped below four. A signal detection model was used, with an on-line pH tracing serving as the criterion response. The events noted as true positives (80%) were an accurate representation by the computer output of the events of pH less than four displayed by the on-line recording. The processing done by this particular ambulatory system tends to actually "ignore" transient pH drops (18% false negatives) and, may, in fact, provide more physiologically meaningful information than hardwired analog techniques for 24-h pH monitoring. The results confirm that ambulatory pH monitoring can produce meaningful and reliable physiological data concerning gastroesophageal reflux.     

Effect of Ambulatory 24-Hour Esophageal pH Monitoring on Reflux-Provoking Activities

Ambulatory 24-hr esophageal pH monitoring isconsidered the gold standard for diagnosinggastroesophageal reflux disease (GERD). The currentapproach is to encourage patients to pursue theireveryday activity in order to obtain near-physiologicalrecordings. However, the effect of the test itself onreflux-provoking activities has never been evaluated.Thus, the aim of our study was to assess daily foodconsumption, habits, symptoms, sleep, and perceivedexperience of patients undergoing pH testing as comparedto an off test (normal) day. Patients reported type andtime spent in each activity pursued, food ingested and length of each meal, habits, frequency andseverity of GERD and other related symptoms, sleepdisturbances, side effects, and overall perceivedexperience during pH testing and four weeks later,during a normal day. Fifty-four patients enrolled. pHtesting significantly reduced time spent being active,number of meals and cups of coffee consumed, andfrequency of GERD symptoms. Almost half of the patients reported having dysphagia during the test. Mostpatients experienced side effects and stated that thetest bothered them most of the time. In conclusion, pHtesting has a significant effect on decreasing reflux-provoking activities — patientstend to assume a more sedentary lifestyle. This mayinfluence the reliability of the test as a physiologicmeasure of acid reflux.     

The Effect of Antisecretory Therapy and Study Duration on Ambulatory Esophageal pH Monitoring

Background  

Conventional catheter-based and wireless pH monitoring continue to be widely used for the evaluation of GERD symptoms despite the emergence of pH-impedance monitoring.     

Dual-Channel Ambulatory Esophageal pH Monitoring (A Useful Diagnostic Tool?)

Ambulatory pH monitoring of the distal esophagusis the most accurate diagnostic study for patients withsuspected gastroesophageal reflux disease (GERD). Themeasurement of proximal esophageal acid exposure time may be useful in patients with atypicalreflux symptoms. The aim of this study is to evaluate ifproximal esophageal pH monitoring provides usefulinformation beyond that learned with distal esophageal pH monitoring. We routinely performeddual-channel pH monitoring with pH electrodes positionedat 20 and 5 cm above the manometric lower esophagealsphincter from January 1992 to August 1995. All patients scored their esophageal symptoms from zero(none) to four (severe). We compared proximal esophagealreflux (PR) in patients with typical symptoms (i.e.,heartburn, regurgitation) and in patients with atypical symptoms (i.e., chest pain, cough, hoarseness,and asthma). We compared symptom profiles betweenpatients with and without PR. We reviewed our experiencein patients with abnormal PR, but with a normal amount of distal esophageal reflux (DR). We studied441 consecutive patients. There were no significantdifferences in PR between patients with typical andatypical symptoms. There were no differences in symptom profiles between patients with normal andabnormal PR. There were no differences of PR between thedifferent atypical symptoms. PR did not correlate withthe severity of the patient's symptoms. PR correlated well only with DR. Twenty-four patients hadisolated abnormal PR, but only six patients improvedwith antireflux therapy. We conclude that routineambulatory esophageal pH monitoring of the proximalesophagus appears to be of little value. The decision tooffer patients an empiric trial of antireflux therapyfor suspected GERD should not be based on the presenceor absence of PR.     

Esophageal pH monitoring

In the 25 years since it was first described, prolonged esophageal pH monitoring has gained increasing acceptance and popularity as a diagnostic and research technique in GER disease. Some recent developments that have contributed to its attraction include compact portable recorders, computerized analysis, short monitoring periods, the good discriminant value of the simple measurement of percent monitoring time that pH is less than 4, and the symptom index, allowing correlation of symptoms with reflux events. Nevertheless, there remain areas of uncertainty with regard to reproducibility and the conditions of monitoring, in particular whether strict dietary control and controlled activity and posture are necessary. There is no universally accepted normal range of values, but it is now apparent that normal and abnormal GER are not appropriately differentiated by simply defining the upper limit of normal using a formula of the mean plus two standard deviations, so other statistical techniques have emerged. Indications for the technique include atypical symptoms, particularly noncardiac chest pain, respiratory symptoms, and, in young children, apneic attacks and recurrent vomiting associated with failure to thrive. The technique is having an impact on the assessment prior to, during, and after medical and surgical therapy for GER, as well as in helping to unravel the complexities of the pathogenesis of esophagitis.     

溃疡样型功能性消化不良食管酸敏感性及胃食管反流的研究

为研究溃疡样型功能性消化不良（FD）食管下端的酸敏感性及病理性胃食管反流,对53例溃疡样型FD患者及20例健康对照者进行了食管的酸敏感性测定,其中47例FD和16例对照者又接受了24小时动态PH检测。结果显示67．9％溃疡样型FD患者酸刺激呈阳性,42．5％溃疡样型FD患者有病理性胃食管反流,显著高于对照组（P＜0．01）。显示食管下端酸敏感性的增高和病理性和病理性胃食管反流可能是疼痛性FD发病的病理生理机制之一。     

Proximal Sensor Data from Routine Dual-Sensor Esophageal pH Monitoring Is Often Inaccurate

Dual-sensor esophageal pH monitoring is routinely used to diagnose GERD. However, the proximal sensor may not be in proximal esophagus in patients with shortened esophagi. Our objective was to determine how often the proximal sensor was misplaced and to determine the effect on pH monitoring. Superior margins of the upper and lower esophageal sphincters (UES and LES) were determined prospectively in consecutive patients. Dual sensors were placed 20 and 5 cm above the LES with a fixed 15-cm spacing pH catheter. Patients were classified into subgroups based on the actual location of the proximal sensor. In 661 patients, the proximal pH sensor was in the hypopharynx in 9% of patients, within the UES in 36%, and in the proximal esophagus in 55%. Spearman's correlation for acid exposure was very good between the dual sensors when the proximal sensor was in the proximal esophagus (R = 0.76) but was poor when the proximal sensor was misplaced in the hypopharynx (R = 0.28). The proximal sensor was misplaced in 45% of patients undergoing dual-sensor esophageal pH monitoring. It is important to locate the UES by manometry before interpreting the proximal esophageal pH data.     

Comparison of Simultaneous Esophageal pH Monitoring and Scintigraphy in Infants with Gastroesophageal Reflux

Twenty-nine infants under 1 yr of age were studied by simultaneous esophageal pH monitoring and scintigraphy for evaluation of gastroesophageal reflux (GER). Scintigraphy and pH monitoring were performed for 120 min after infants ingested their usual volume of formula. The number of reflux episodes during six 20-min intervals, as determined by both tests, were recorded. Esophageal pH monitoring was continued for 18–24 h. Sixteen of 29 patients exhibited GER by pH monitoring during the 2-h study. Gastroesophageal reflux occurred in seven of 29 during the first hour and 13 of 29 during the second hour. The mean time of first reflux episode detected by pH monitoring following the feeding was 82.4 ± 49.3 min. In comparison, 28 of 29 patients had GER by scintigraphy during the 2 h. All 28 exhibited GER during the first hour, whereas only 22 of 29 patients exhibited GER during the second hour. The mean time of first episode of reflux by scintigraphy was 3.1 ± 2.7 min. Forty-five percent of all reflux episodes detected by scintigraphy occurred during the first 20 min and 80% were detected during the first hour. In contrast, only 17% of reflux episodes were seen by pH monitoring during the first 20 min and 35% during the first hour; 65% of reflux episodes detected by pH monitoring were during the second hour. There was no correlation between the total number of reflux episodes detected by scintigraphy and 2-h esophageal pH monitoring during the 2-h study period ( r = 0.326; p > 0.1). Overall, to detect reflux, scintigraphy was a more sensitive method than esophageal pH monitoring under the conditions of this study. Scintigraphy selectively detected reflux during the first 60 min postprandially whereas pH monitoring was more likely to detect reflux beyond the first postprandial hour. These observations help to explain the lack of correlation between the two tests.